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Case Study

Secondary to Proliferative Glomerulonephritis
Dr Jawahar J Shah

A girl aged 12.5 years came to my clinic on 21.5.94.with the following complaints.
1. Frequent headaches with vomiting since 2 years. 
2. Frequent bilateral ear pain.
3. Dysmenorrhoea and swelling of the legs since 4 days
4. Exhaustion on the least physical exertion.
5. Occasional cold and coryza with every change of weather
6. She underwent surgery for bilateral club-foot in 1988, which was detected only at the age of 4 years .

Appetite: good 
Carvings: salted things, ice-creams, cold drinks , chicken and chocolates.
Thirst: increases
Perspiration: reduced
Sleep refreshing 
Urine normal; Bowels regular
Birth record:
Birth weight: 6 lbs teething at normal time; other milestones like walking(1.5years ) and talking(2years ) were delayed. No history of pica. Menarche at the age of 12. 

Past History:
1. Otitis with bleeding Rt ear at age of 7 months.
2. Mumps at 9 years
3. Typhoid at 10 years.
4. Bleeding from left ear in April 1994- at 12.5y,
5. Dermatitis which was now relieved.

Family History
1. Hypertension on father's side.
2. Renal "problems" on mother's side.

She wanted fan all the time and liked winter .Preferred cold water bath . On the mental sphere, there was marked anger < when contradicted .Shouts when angry .Forces others to bend to her will. Stubborn. Fought with her brother, whom she otherwise loved the most .She was very attached to her dog. When in good mood ,she could be very affectionate and generous with her things . Very shy towards strangers . Never tolerates anybody dominating her .Would bite her nails constantly and was scared of ghosts. Doesnt like to study. 

1) Renal biopsy - proliferate glomerulonephritis.
2) Ophthalmoscopy - papilloedema, Retinal arterial hypertension.
3) Serum Creatinine - raised.

Weight - 35 kgs, dark rings around the eyes, hyper-extensible fingers, nose congested, BP: 90/70 mmHg.

21.5.94 - based on the mentals , and known action of Stramonium on congestive states, I gave Stramonium 200, 1 dose; Sac-lac for 7 days.
27.5.94 - HEADACHE > in intensity; gave placebo for 10 days.
6.6.94 - Headache > but present .Skin itching all over the body. Eruptions on back and legs .
Ophthalmoscopy: regression stage of papilloedema.
IOP - normal; retinal oedema + but no exudate; Grade IV hypertension of retinal vessels: gave placebo for 3 weeks.
1.7.94- Papilloedema reduced: occasional headache cold + Stramonium 200 ,second dose .
30.7.94 - Parents informed that her anger had become more .Headache which had been better after the previous dose, had recurred on 26-7-94. Papilloedema Bettter but present; cough and coryza: Thuja -200, three weekly doses, as intercurrent.
10.8.94; Ophthalmoscopy; [R].eye; Regression of all signs; blood vessels back to normal .AV changes reduced totally .Papilloedema restricted only to a small portion. Height of papilloedema 1 Dioptre as compared to +3 D previously. 
[L] eye: regression of all symptoms .Papilloedema totally regressed. Optic nerve healthy.
12.1.95 - Ophthalmologist's Report :
[R] eye: No changes of hypertensive changes.(not even Grade I )
[L] eye: Disc -healthy colour; no oedema.